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Tracheostomy Care Procedure

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Tracheostomy Care Procedure

Key Points

  • Routine tracheostomy care lowers bacterial entry into the airway and supports tube patency.
  • Inner cannula care is performed at least every 12-24 hours, with more frequent care for heavy secretions.
  • Dressing should be changed at least once per shift and immediately when wet or soiled.
  • Inner cannula replacement/cleaning should precede dressing replacement to avoid immediate contamination from cough-stimulated secretions.

Equipment

  • Tracheostomy care kit per facility standard
  • Replacement or cleaning supplies for inner cannula type in use
  • Sterile normal saline, split sponge dressing, and sterile applicators/gauze
  • Sterile brush/pipe cleaners and replacement securement ties
  • Clean tracheostomy dressing materials
  • Personal protective equipment
  • Emergency bedside airway backup set (obturator, same-size and one-size-smaller spare tracheostomy tubes, lubricant, cuff syringe, spare ties/securement, bag-valve mask)
  • Pulse oximetry for pre/post monitoring

Procedure Steps

  1. Verify airway stability, baseline respiratory status, and supplies; position in semi-Fowler and optimize visualization/access.
  2. Confirm emergency tracheostomy replacement equipment is present and immediately reachable at bedside.
  3. Perform tracheal suctioning first if clinically indicated before routine tracheostomy site care.
  4. Remove old dressing and inspect drainage characteristics (amount, color, odor), then inspect stoma for redness, warmth, tenderness, drainage, and skin breakdown.
  5. Prepare sterile field per policy and determine whether inner cannula is disposable or reusable.
  6. Remove inner cannula and maintain oxygen support during cannula exchange/cleaning when needed (assistant support may be required).
  7. Clean reusable inner cannula with sterile brush in saline, rinse, dry, reinsert, lock securely, and reconnect preexisting oxygen setup.
  8. Clean stoma and flange with sterile saline using fresh gauze/applicators each pass; avoid hydrogen peroxide mixtures because they may impair healing.
  9. Dry area completely and apply sterile split tracheostomy dressing by touching outer edges only.
  10. Replace tracheostomy ties using two-person technique when available to reduce accidental decannulation risk; secure to allow one-finger fit beneath tie.
  11. Provide oral care and complete post-care reassessment; if mechanically ventilated, maintain head-of-bed approximately 30-45 degrees to reduce VAP risk.
  12. Document procedure details (sterile technique, cannula action, dressing change, stoma findings, tolerance), and report/escalate abnormal findings promptly.
  13. Repeat care at least every 12-24 hours, inspect inner cannula at least twice daily, and increase frequency with heavy/thick secretions.

Common Errors

  • Changing dressing before inner cannula care → newly applied dressing is rapidly soiled by induced coughing.
  • Delaying routine cannula maintenance → increased risk of tracheostomy tube obstruction.
  • Leaving wet or soiled dressing in place → higher local bacterial burden and skin breakdown risk.
  • Incomplete post-care reassessment → delayed recognition of persistent airway compromise.
  • Suctioning through a fenestrated tube without proper nonfenestrated inner-cannula setup → severe tracheal injury risk.
  • Using hydrogen peroxide mixtures on routine stoma cleansing → delayed local healing and tissue irritation risk.
  • Tie changes without tube stabilization or incorrect tie tension → increased accidental decannulation/pressure injury risk.

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